How does a woman’s vulvovaginal area change?

This week’s question to Dr. Marie is about a woman’s vulvovaginal area.

Ask Dr. Marie: How does a woman’s vulvovaginal region change as she ages?

What is the vulva in the vulvovaginal region?

First let’s distinguish between vulva and vagina. The vulva is the external genitalia consisting of pubic mons, clitoris and hood, outer labia, inner labia, urethral and vaginal introitus, ducts of Skene’s and Bartholin’s glands and perineum. The external genitalia is ambiguous in 1 to 1,500 to 1 to 20,000 newborns and the statistics increase with age.

How does the vulva change?

The Tanner stages are how the medical profession measures the development of external genitalia caused by the increase in estrogen. Pubic hair grows, the clitoris, the labia and pubic mons increase in size. External genitalia are not symmetrical. As a woman passes puberty, blood flow increases to the labia and the clitoris, increasing sensitivity. As the vulva ages and estrogen levels drop, elasticity decreases. Gravity and fatty deposits cause the vulva to take a different shape. Color of the skin can also change. Pubic hair thins. The Bartholin’s and Skene’s glands provide less lubrication. The external genitalia of the vulvovaginal area becomes more prone to injury.

What is the vagina in the vulvovaginal region?

The vagina is a muscular canal with a mucosal lining. The lining forms folds called rugae which allow the vagina to contract. At puberty, the mucosal cells thicken and excrete lubrication. The G-spot located on the anterior (front) wall of the vagina generally has a different texture – anywhere from rough to spongy – than the rest of the vaginal canal.

How does the vagina change?

As a woman approaches menopause and estrogen levels fall, the walls thin and the rugae become less pronounced. With the decrease in lubrication of the vulvovaginal area, the vagina is more prone to injury. Micro tears and infection are more possible as balance of vaginal flora changes. The close proximity of the vaginal opening to the urethra increases the risk of urinary infections. The ligaments holding the uterus and bladder can also weaken causing prolapse of either organ. As the vagina is muscular it is important to maintain the muscular tone with Kegel exercises. Using lubricant to prevent dryness and injury also promotes vaginal health. Other options are bio-identical hormone therapies and herbal formulas that promote hormonal balance.